Miae Lee, CRNA – Anesthesiology Physician

Key facts

NPI: 1154423770
Entity type: Individual (NPI type 1)
Primary specialty: Anesthesiology Physician 207L00000X
License: CRNA2665 (CA)
Practice address: 3300 Renner Dr
Fortuna, CA 95540-3120
Phone: (707) 725-3361
NPI assigned: Sep 3, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Pacific Memorial Anesthesia Care, Inc Anesthesiology Physician · Fortuna, CA · NPI 1750406146

Medicare reassignment NPD ANESTHESIOLOGY · CA
Willits Hospital Inc. Critical Access Hospital · Willits, CA · NPI 1356339543

Medicare reassignment NPD CA
Ukiah Adventist Hospital Community/Retail Pharmacy · Willits, CA · NPI 1629432968

NPD
American Hospital Management Corporation Rural Health Clinic/Center · Arcata, CA · NPI 1609979707

NPD (past)

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

St. Joseph Health Northern California, LLC Critical Access Hospital · Fortuna, CA · NPI 1043292303

Care Compare affiliation Hospital
St. Joseph Health Northern California, LLC Critical Access Hospital · Fortuna, CA · NPI 1285849026

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Certified Registered Nurse Anesthetist (Crna)
Education: Other, 2000
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361

Hospital & facility affiliations

Providence Redwood Memorial Hospital Hospital · Fortuna, CA · CCN 051318

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20040219000322	CA	Practitioner - Certified Registered Nurse Anesthetist (Crna)	6709771611	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
CRNA2665	CA	MD	Anesthesiology Physician

Practice roles

Organization	Specialty	Status	New patients
Pacific Memorial Anesthesia Care, Inc	Anesthesiology	Current since Sep 8, 2009	Accepting new patients
Ukiah Adventist Hospital		Current since Mar 30, 2010	Accepting new patients
Willits Hospital Inc.		Current since Mar 30, 2010	Accepting new patients
American Hospital Management Corporation		Past	Accepting new patients

Locations

3800 Janes Rd
Arcata, CA 95521
Phone (707) 822-3621

3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361

1 Marcela Dr
Willits, CA 95490
Phone (707) 456-3001

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Anesthesiology Physician	207L00000X	CRNA2665	CA	Yes

Addresses

Primary practice location

3300 Renner Dr
Fortuna, CA 95540-3120

Mailing address

PO Box 5486
Orange, CA 92863-5486
Phone (818) 550-0900

Other identifiers

Identifier	Type	State	Issuer
RN4693190	Medicaid	CA

Other providers in Fortuna, CA

All providers in Fortuna, CA · Anesthesiology Physician in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.